scholarly journals Higher Levels of Cystatin C Are Associated with Extracranial Carotid Artery Steno-Occlusive Disease in Patients with Noncardioembolic Ischemic Stroke

2016 ◽  
Vol 6 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Toshitaka Umemura ◽  
Takahiko Kawamura ◽  
Shinichi Mashita ◽  
Takashi Kameyama ◽  
Gen Sobue
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Cystatin C ◽  
Characteristic Curve ◽  
Lipid Lowering ◽  
Large Artery ◽  
Tandem Stenosis ◽  
Hs Crp ◽  
Ica Stenosis ◽  
Extracranial Ica

Background: Large artery atherosclerosis is a major cause of ischemic stroke worldwide. Differential biomarker profiles associated with extra- and intracranial atherosclerosis are a topic of considerable interest. Cystatin C (CysC), a marker of renal function, is a risk factor for cardiovascular disease. Aim: We sought to determine whether CysC levels were associated with extra- and intracranial large artery stenosis (LAS) in patients with acute ischemic stroke. Methods: We retrospectively analyzed data of acute noncardioembolic ischemic stroke patients who were admitted to our stroke center within 5 days from symptom onset. Serum CysC levels were measured using latex agglutination turbidimetric immunoassay. Extra- and intracranial LAS were defined as ≥50% diameter stenosis or occlusion of the relevant internal carotid artery (ICA) and/or middle cerebral artery (MCA) using carotid echography and volume rendering on magnetic resonance angiography. Multivariate logistic analyses were used to assess the association between CysC levels and LAS after adjustment for potential confounders. Results: Of 205 patients (mean age 70.2 years), 76 (37.1%) had LAS. The distribution of LAS was 29 extracranial ICA, 34 intracranial ICA/MCA (8 ICA only, 25 MCA only, 1 ICA+MCA) and 13 tandem stenosis (both extracranial ICA and intracranial ICA/MCA). Levels of CysC were higher in patients with extracranial ICA stenosis than in those with intracranial ICA/MCA stenosis (1.23 ± 0.33 vs. 0.97 ± 0.21 mg/l, p < 0.001). In multivariate analysis, the highest CysC tertile (>1.04 mg/l) was significantly associated with extracranial ICA stenosis (adjusted odds ratio [OR] 5.01, 95% confidence interval [CI] 1.51-16.63, p = 0.009) after adjustment for age, sex, diabetes, chronic kidney disease, current smoking, systolic blood pressure, HDL cholesterol, high-sensitivity C-reactive protein (hs-CRP) and premorbid lipid-lowering drugs use. When CysC was considered as a continuous variable, 1 SD increase in CysC was significantly associated with extracranial ICA stenosis (adjusted OR 3.01, 95% CI 1.58-5.72, p = 0.001). However, there were no significant associations between CysC levels and intracranial ICA/MCA stenosis. In addition, CysC levels showed a weak but statistically significant correlation with hs-CRP levels (r = 0.195, p = 0.021). Using receiver operating characteristic curve analysis, CysC value displayed good performance in discriminating extracranial ICA stenosis (c-statistic 0.79, 95% CI 0.69-0.89, p < 0.001). Conclusions: This preliminary study suggests that higher levels of CysC were independently associated with symptomatic extracranial ICA stenosis, but not with intracranial ICA/MCA stenosis in patients with noncardioembolic stroke. Our findings provide new insights into the link between serum CysC and carotid atherosclerosis.

scholarly journals Can intracranial time-of-flight-MR angiography predict extracranial carotid artery stenosis?

2021 ◽  
Author(s):  
Filiz Osmanodja ◽  
Jan F. Scheitz ◽  
Jochen B. Fiebach ◽  
Ramanan Ganeshan ◽  
Kersten Villringer
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Mr Angiography ◽  
Control Group ◽  
High Grade ◽  
Tof Mra ◽  
Sensitivity Specificity ◽  
Ica Stenosis ◽  
Extracranial Stenosis ◽  
Extracranial Ica

Abstract Objectives Extracranial stenosis of the internal carotid artery (ICA) is an important cause of ischemic stroke and transient ischemic attack (TIA). It can be diagnosed using contrast-enhanced CT or MR angiography (MRA) as well as Doppler ultrasound. In this study, we assessed the diagnostic value of intracranial time-of-flight (TOF) MRA to predict extracranial ICA stenosis (ICAS). Methods We retrospectively analyzed consecutive patients with acute ischemic stroke or TIA and middle- (50–69%) or high-grade (70–99%) unilateral extracranial ICAS according to NASCET criteria assessed by ultrasound between January 2016 and August 2018. The control group consisted of patients without extracranial ICAS. Intraluminal signal intensities (SI) of the intracranial ICA on the side of the extracranial stenosis were compared to the contralesional side on TOF-MRA source images. SI ratios (SIR) of contralesional:lesional side were compared between groups. Results In total, 151 patients were included in the main analysis. Contralesional:lesional SIR in the intracranial C4-segment was significantly higher in patients with ipsilateral extracranial ICA stenosis (n = 51, median 74 years, 57% male) compared to the control group (n = 100, median 68 years, 48% male). Mean SIR was 1.463 vs. 1.035 (p < 0.001) for right-sided stenosis and 1.362 vs. 1.000 (p < 0.001) for left-sided stenosis. Receiver-operating characteristic curve demonstrated a cut-off value of 1.086 for right-sided [sensitivity/specificity 75%/81%; area under the curve (AUC) 0.81] and 1.104 for left-sided stenosis (sensitivity/specificity 70%/84%; AUC 0.80) in C4 as a good predictor for high-grade extracranial ICAS. Conclusions SIR on TOF-MRA can be a marker of extracranial ICAS.

scholarly journals Association of Carotid Artery Endothelial Signal Intensity Gradient with Unilateral Large Artery Ischemic Stroke

2021 ◽  
Vol 50 (3) ◽  
pp. 270-278
Author(s):  
Chan-Hyuk Lee ◽  
Sang Hyuk Lee ◽  
Young I. Cho ◽  
Seul-Ki Jeong
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Signal Intensity ◽  
Internal Carotid ◽  
University Hospital ◽  
Large Artery ◽  
Intensity Gradient ◽  
National University ◽  
Endothelial Shear Stress ◽  
Stroke Center

<b><i>Background:</i></b> Common carotid artery (CCA) and internal carotid artery (ICA) are aligned linearly, but their hemodynamic role in ischemic stroke has not been studied in depth. <b><i>Objectives:</i></b> We aimed to investigate whether CCA and ICA endothelial shear stress (ESS) could be associated with the ischemic stroke of large artery atherosclerosis (LAA). <b><i>Methods:</i></b> We enrolled consecutive patients with unilateral ischemic stroke of LAA and healthy controls aged &#x3e;60 years in the stroke center of Jeonbuk National University Hospital. All patients and controls were examined with carotid artery time-of-flight magnetic resonance angiography, and their endothelial signal intensity gradients (SIGs) were determined, as a measure of ESS. The effect of right or left unilateral stroke on the association between carotid artery endothelial SIG and ischemic stroke of LAA was assessed. <b><i>Results:</i></b> In total, the results from 132 patients with ischemic stroke of LAA and 121 controls were analyzed. ICA endothelial SIG showed significant and independent associations with the same-sided unilateral ischemic stroke of LAA, even after adjusting for the potential confounders including carotid stenosis, whereas CCA endothelial SIG showed a significant association with the presence of the ischemic stroke of LAA. <b><i>Conclusion:</i></b> Although CCA and ICA are located with continuity, the hemodynamics and their roles in large artery ischemic stroke should be considered separately. Further studies are needed to delineate the pathophysiologic roles of ESS in CCA and ICA for large artery ischemic stroke.

scholarly journals Plasma Osteoprotegerin Correlates with Stroke Severity and the Occurrence of Microembolic Signals in Patients with Acute Ischemic Stroke

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Yanyan Cao ◽  
Congxian Cui ◽  
Hongqin Zhao ◽  
Xudong Pan ◽  
Wenjian Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
National Institutes Of Health ◽  
Atherosclerotic Plaques ◽  
Stroke Severity ◽  
Large Artery ◽  
Unstable Plaque ◽  
Cutoff Value ◽  
Operating Characteristic Curve

Background. Instability of atherosclerotic plaques is associated with the occurrence of stroke. Microembolic signals (MESs) are an indicator of unstable plaque. A relationship between plasma osteoprotegerin (OPG) and ischemic stroke has already been identified. The aim of this study was to investigate whether plasma OPG levels have a relationship with MESs and to evaluate the feasibility of OPG as a biomarker of stroke severity and occurrence of MESs. Methods. Our study consisted of 127 patients with large artery atherosclerosis stroke and 56 controls. Patients were classified into subgroups based on stroke severity and the occurrence of MESs. MES-monitoring was performed for 60 min using transcranial Doppler within 72 h of stroke onset. Stroke severity at admission was assessed by the National Institutes of Health Stroke Scale. Results. Plasma OPG levels were significantly associated with stroke, MESs, and stroke severity at admission (adjusted OR [95% CI]: 1.002 [1.001–1.003] p<0.001; 1.002 [1.001–1.003] p=0.001; 1.001 [1.000–1.002] p=0.028). When plasma OPG levels were used to determine the stroke severity, the area under the receiver-operating characteristic curve (AUC) was 0.734 (95% CI: 0.625-0.843) based on a cutoff value of 1998.44 pg/ml; the sensitivity and specificity of this test were 80.6% and 65.6%, respectively. Furthermore, when the levels of OPG were used to distinguish the presence of MESs, the AUC was 0.766 (95% CI: 0.672-0.860); the cutoff value was 2107.91 pg/ml. The sensitivity of this cutoff value was 68.8% and the specificity was 73.7%. Conclusions. Plasma OPG levels correlate with stroke severity and the occurrence of MESs.

Emergent Carotid Thromboendarterectomy for Acute Symptomatic Occlusion of the Extracranial Internal Carotid Artery

2017 ◽  
Vol 51 (4) ◽  
pp. 176-182 ◽  
Author(s):  
Igor Gunka ◽  
Dagmar Krajickova ◽  
Michal Lesko ◽  
Stanislav Jiska ◽  
Jan Raupach ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Time Interval ◽  
Nihss Score ◽  
Carotid Revascularization ◽  
Extracranial Ica

Background: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. Methods: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015. Primary outcomes were disability at 90 days assessed by the modified Rankin Scale (mRS) and neurological deficit at discharge assessed using the National Institute of Health Stroke Scale (NIHSS). Secondary outcomes were the recanalization rate, 30-day overall mortality, and any intracerebral bleeding. Results: During the study period, a total of 6 patients (5 men and 1 woman) with a median age of 64 years (range: 58-84 years) underwent emergent reconstruction for acute symptomatic ICA occlusion within a median of 5.4 hours (range: 2.9-12.0 hours) after symptoms onset. The median presenting NIHSS score was 10.5 points (range: 4-21). Before surgery, 4 patients (66.7%) had been treated by systemic recombinant tissue plasminogen activator lysis. The median time interval between initiation of intravenous thrombolysis and carotid thromboendarterectomy was 117.5 minutes (range: 65-140 minutes). Patency of the ICA was achieved in all patients. On discharge, the median NIHSS score was 2 points (range: 0-11 points). There was no postoperative intracerebral hemorrhage and zero 30-day mortality rate. At 3 months, 5 patients (83.3%) had a good clinical outcome (mRS ≤ 2). Conclusion: Patients presenting with minor to severe ischemic stroke syndromes due to isolated extracranial ICA occlusion may benefit from emergent carotid revascularization. Thorough preoperative neuroimaging is essential to aid in selecting eligible candidates for acute surgical intervention.

scholarly journals Hemodynamics and oxygen extraction in chronic large artery steno-occlusive disease: Clinical applications for predicting stroke risk

2017 ◽  
Vol 38 (9) ◽  
pp. 1584-1597 ◽  
Author(s):  
Colin P Derdeyn
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Stroke Risk ◽  
Arterial Stenosis ◽  
Oxygen Extraction Fraction ◽  
Oxygen Extraction ◽  
Large Artery ◽  
Extraction Fraction ◽  
Hemodynamic Assessment

Depending on the adequacy of collateral sources of blood flow, arterial stenosis or occlusion may lead to reduced perfusion pressure and ultimately reduced blood flow in the distal territory supplied by that vessel. There are two well-defined compensatory mechanisms to reduced pressure or flow – autoregulatory vasodilation and increased oxygen extraction fraction. Other changes, such as metabolic downregulation, are likely. The positive identification of autoregulatory vasodilation and increased oxygen extraction fraction in humans is an established risk factor for future ischemic stroke in some disease states such as atherosclerotic carotid stenosis and occlusion. The mechanisms by which ischemic stroke may occur are not clear, and may include an increased vulnerability to embolic events. The use of hemodynamic assessment to identify patients with occlusive vasculopathy at an increased risk for stroke is very appealing for several different patient populations, such as those with symptomatic intracranial atherosclerotic disease, moyamoya phenomenon, complete internal carotid artery occlusion, and asymptomatic cervical carotid artery stenosis. While there is very good data for stroke risk prediction in some of these groups, no intervention based on these tools has been proven effective yet. In this manuscript, we will review these topics above and identify areas for future research.

scholarly journals Mecobalamin and early functional outcomes of ischemic stroke patients with H-type hypertension

2018 ◽  
Vol 64 (5) ◽  
pp. 428-432
Author(s):  
Meixia Yuan ◽  
Beiyun Wang ◽  
Shijin Tan
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Carotid Artery ◽  
Conventional Therapy ◽  
Functional Outcomes ◽  
Inflammatory Factors ◽  
Control Group ◽  
Serum Homocysteine ◽  
The Difference ◽  
Hs Crp

SUMMARY OBJECTIVE To analyze the effect of mecobalamin on the early-functional outcomes of patients with ischemic stroke and H-type hypertension. METHODS From October of 2014 to October of 2016, 224 cases of ischemic stroke and H-type hypertension were selected. The patients were randomly divided into treatment control groups, with 112 patients in each group. The control group was treated with the conventional therapy. The observation group was treated with 500 µg of mecobalamin three times a day in addition to the conventional therapy. We compared serum homocysteine (Hcy), hs-CRP levels, carotid plaques, and NIHSS scores between the two groups on the 2nd day and at 4 weeks, 8 weeks, 3 months, and 6 months. RESULTS After 4 weeks, 8 weeks, 3 months and 6 months, the difference of serum Hcy level between the two groups was statistically significant (t = 4.049, 3.896, 6.052, 6.159, respectively. All P <0.05). After the treatment, at 4 weeks, 8 weeks, 3 months and 6 months, the levels of hs-CRP in the treatment group were significantly lower than those in the control group (t = 37.249, 28.376, 26.454, 20.522, respectively. All P <0.01). After 3 months and 6 months, the carotid artery plaques were significantly reduced in the treatment group compared to those in the control group (t = 2.309 and 2.434. All P <0.05). After 3 months and 6 months, the NIHSS score was significantly higher in the treatment group compared to those in the control group (t = 2.455 and 2.193. All P <0.05). CONCLUSION Mecobalamin can reduce the level of plasma homocysteine, then lead to reductions of levels of plasma inflammatory factors and volume of carotid artery plaques, resulting in more significant functional recovery.

scholarly journals INDICATIONS TO SURGICAL TREATMENT OF ATHEROSCLEROTIC IMPACT OF THE CAROTID ARTERIES

2020 ◽  
pp. 76-80
Author(s):  
I. S. Puliayeva
Keyword(s):  
Ischemic Stroke ◽  
Surgical Treatment ◽  
Carotid Artery ◽  
Carotid Arteries ◽  
Recurrent Stroke ◽  
Comprehensive Treatment ◽  
Hemorrhagic Complication ◽  
Atherosclerotic Lesions ◽  
Asymptomatic Patients ◽  
Ica Stenosis

Summary. Goal. To analyze the indications for surgical treatment of symptomatic and asymptomatic stenosis of the internal carotid artery. Materials and methods. The well-known tactics of performing carotid endarterectomy in symptomatic and asymptomatic patients still need to be divided into groups with symptomatic and asymptomatic ICA stenosis, depending on the clinical course of the disease and the risk of developing stroke. Of the 140 patients enrolled in the study, 60 patients formed patients with symptomatic ICA lesions, namely: a) 50 patients with symptomatic ICA stenosis; b) 10 patients with visual impairment and ICA stenosis. Of 80 asymptomatic patients with verified atherosclerotic lesions of the carotid arteries without manifestations of acute ischemic cerebral circulation during the last 6 months, of which. Discussion and results. Patients with symptomatic ICA lesions are the most at-risk group for the development of recurrent stroke, they require comprehensive treatment depending on the size of the lesion and the risk of hemorrhagic complication. Conclusions. Patients with multifocal atherosclerosis should be screened for carotid artery screening to reduce the risk of ischemic stroke in the postoperative period. Patients with ischemic stroke should perform an MRI to confirm the focus of the first stage, followed by ultrasound examination of the carotid arteries. In the case of carotid lesions, patients undergo carotid CT scans to establish indications for surgical treatment.

Abstract W P149: High-Sensitivity C-Reactive Protein, but Not Lipoprotein-Associated Phospholipase A2, May Predict the Unfavorable Outcome After Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jae Guk Kim ◽  
Youngchai Ko ◽  
Soo Joo Lee
Keyword(s):  
Ischemic Stroke ◽  
High Sensitivity ◽  
Mean Value ◽  
Unfavorable Outcome ◽  
Stroke Severity ◽  
Large Artery ◽  
C Reactive Protein ◽  
Nihss Score ◽  
Reactive Protein ◽  
Hs Crp

Background and Objectives: Inflammation plays an important role in atherosclerosis and its clinical sequelae. Their relationship to stroke is not settled. We assessed the hypothesis that relative elevations of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels at the time of first stroke are associated with stroke severity and prognosis. Methods: First ischemic stroke patients who was admitted within 7days after stroke onset, were prospectively enrolled. High-sensitivity C-reactive protein and Lp-PLA2 level were assayed using the enzyme-linked immunoassay. Vascular risk factors, stroke subtypes, and initial stroke severity were assessed. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) and was categorized as mild (NIHSS score<6), moderate (NIHSS score of 6-13), or severe (NIHSS score≥14). The unfavorable outcome was defined as the modified Rankin Scale of 2-6 at 3month after stroke onset. Results: Two hundred two patients (mean age, 67.5 years; 52.5% male) were included; 104 (51.5%) had unfavorable outcome. Levels of hs-CRP and Lp-PLA2 were weakly correlated (Spearman’s rho=0.174, p=0.01). In univariate analyses, female (p=0.03), patients with large artery atherosclerosis of stroke subtypes (p<0.01), severe NIHSS score (p=0.01), and unfavorable outcome (p<0.01) showed the higher mean value level of hs-CRP level than the others. Patients with hypertension (p=0.03), large artery atherosclerosis (p<0.01), severe NIHSS score (p<0.01), and unfavorable outcome (p=0.01) also had the higher mean value of Lp-PLA2 level than the others. After adjusting for age, sex, vascular risk factors, and initial stroke severity, the high level of hs-CRP was associated with unfavorable outcome (1.71±4.2 vs. 0.26±0.45, odds ratio (OR) 1.82, 95% confidence interval (CI) 1.02-3.27, p=0.04). However, after adjusting for the confounders, Lp-PLA2 was not associated with unfavorable outcome (191.33±77.78 vs. 162.02±61.54, OR 1.00, 95% CI 0.99-1.01, p=0.66). Conclusion: Our findings suggest that the level of hs-CRP and Lp-PLA2 were associated with stroke severity, but only hs-CRP may be useful to predict functional outcome at 3 month after ischemic stroke.

scholarly journals Impact of Severe Extracranial ICA Stenosis on MRI Perfusion and Diffusion Parameters in Acute Ischemic Stroke

2014 ◽  
Vol 5 ◽  
Author(s):  
Philipp Kaesemann ◽  
Götz Thomalla ◽  
Bastian Cheng ◽  
Andras Treszl ◽  
Jens Fiehler ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diffusion Parameters ◽  
Ica Stenosis ◽  
And Diffusion ◽  
Extracranial Ica

scholarly journals Clinical, Laboratory, and Imaging Characteristics of Transient Ischemic Attack Caused by Large Artery Lesions: A Comparison between Carotid and Intracranial Arteries

2015 ◽  
Vol 5 (3) ◽  
pp. 115-123 ◽  
Author(s):  
Toshiyuki Uehara ◽  
Tomoyuki Ohara ◽  
Kazunori Toyoda ◽  
Kazuyuki Nagatsuka ◽  
Kazuo Minematsu
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Transient Ischemic Attack ◽  
Clinical Laboratory ◽  
Stroke Care ◽  
Large Artery ◽  
Intracranial Artery ◽  
Imaging Characteristics ◽  
Artery Disease ◽  
Ischemic Attack

Background/Aims: The aims of this study were to determine the differences in clinical characteristics and the risk of ischemic stroke between patients with transient ischemic attack (TIA) attributable to extracranial carotid and intracranial artery occlusive lesions. Methods: Among 445 patients admitted to our stroke care unit within 48 h of TIA onset between April 2008 and December 2013, 85 patients (63 men, mean age 69.4 years) with large artery occlusive lesions relevant to symptoms were included in this study. The primary endpoints were ischemic stroke at 2 and 90 days after TIA onset. Results: Twenty-eight patients had carotid artery occlusive lesions (extracranial group), and 57 patients had intracranial artery occlusive lesions (intracranial group). Patients in the intracranial group were significantly younger, had lower levels of fibrinogen, and were less likely to have occlusion when compared with those in the extracranial group. Eleven patients in the extracranial group and none in the intracranial group underwent revascularization procedures within 90 days of TIA onset. The 2-day risk (14.2 vs. 0%, p = 0.044) and the 90-day risk (17.1 vs. 0%, p = 0.020) of ischemic stroke after TIA onset were significantly higher in the intracranial group than in the extracranial group. Conclusions: Among our patients with TIA caused by large artery disease, patients with intracranial artery occlusive lesions were more frequent and were at higher risk of early ischemic stroke than those with extracranial carotid artery occlusive lesions. These data highlight the importance of prompt assessment of intracranial artery lesions in patients with TIA.

Sign in / Sign up

Export Citation Format

Share Document